Methotrexate and Folic Acid Patient Handout

METHOTREXATE (MTX) & FOLIC ACID Patient Handout – Print & Take to Your Doctor

---

Name: _________________________
MTX Dose: ______ mg weekly on ________ (day)
Folic Acid Plan: □ 5 mg once weekly on ________ (day)
        □ 1 mg daily (except MTX day)

---

Why You Need Folic Acid

• MTX blocks folate → causes side effects like mouth sores, nausea, low blood counts, liver issues.
• Folic acid protects you without weakening MTX’s good effects (in arthritis/psoriasis).

---

Your Folic Acid Schedule

---

How to Take Folic Acid

• Tablet: 1 mg (white) or 5 mg (yellow) – swallow with water/food
• If 5 mg upsets stomach: Ask pharmacist to split into 2.5 mg × 2
• Missed dose? Take as soon as you remember unless it’s MTX day

---

Foods High in Natural Folate (Eat Daily)

• Spinach, kale, broccoli
• Lentils, chickpeas, black beans
• Avocado, oranges, fortified cereal

---

Warning Signs – Call the Doctor

• Mouth sores that won’t heal
• Severe nausea/diarrhea
• Unusual bruising or bleeding
• Yellow skin/eyes (liver)
• Extreme fatigue

---

Lab Monitoring Schedule

---

Important Notes

• Pregnant or planning? STOP MTX immediately – call the doctor.
• Cancer patients: Use leucovorin (IV) only – not folic acid.
• Alcohol: Limit or avoid – increases liver risk.
• Multivitamins: OK except on MTX day (most have <0.4 mg folic acid).

---

Pharmacy Tip:
Ask for generic folic acid 1 mg (affordable, approximately $4 for 100 tablets).
No prescription needed in most places.

---

Questions? Call:
Rheumatologist: _________________________
Pharmacist: ____________________________
Emergency: 911 or local ER

---

Print 2 copies: 1 for fridge, 1 for wallet.
Handout based on ACR/EULAR/BSR guidelines – last updated 2025